A message from Seton Healthcare Family Vice Presidents of Medical Affairs

The Seton facilities participating in Joint Commission surveys this year have been cited for using order sets that have the potential to result in THERAPEUTIC DUPLICATIONS (i.e., certain order sets that offer multiple drugs for the same clinical indication without clear criteria for selecting the use of one drug over another). The Joint Commission surveyors point out that the risk of therapeutic duplication arises when the order set can be interpreted to allow the nurse or patient to choose the drug or dose. Such a practice would violate both TJC and CMS guidelines. We believe order sets that may invite unintended therapeutic duplication constitute a valid patient safety risk and also present a risk that such orders may prompt nurses to function outside of their scope of practice.

Common examples include order sets that offer multiple options for prn pain medication, nausea, constipation and sleep.

Work is currently underway to identify and correct order sets that contain and/or allow for unintended therapeutic duplications, but there are several hundred order sets that must be reviewed and revised. The immediate focuses are the order sets specifically identified during the survey in orthopedics, obstetrics and internal medicine. On a go-forward basis, all order sets (paper and COMPASS) will be constructed so as to minimize the potential for unintended therapeutic duplication.

Please be conscious of this issue as you write orders. If pharmacy receives orders that contain therapeutic duplications physicians WILL be called for clarification.